{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T04:59:58Z","timestamp":1790312398363,"version":"4.1.0"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:p>Surgical management of colorectal cancer with synchronous liver and lung metastases (CRC-SLLM) remains challenging because of marked clinical heterogeneity, and reliable tools for individualized risk assessment are lacking. We aimed to develop and externally validate a nomogram for overall survival (OS) prediction and to explore its potential value in guiding selection for primary tumor resection (PTR). Patients diagnosed with CRC-SLLM between 2010 and 2015 were identified from the Surveillance, Epidemiology, and End Results (SEER) database and randomly assigned to a training cohort (n = 808) and an internal validation cohort (n = 345) in a 7:3 ratio, whereas external validation was performed using 65 patients from the Fourth Hospital of Hebei Medical University, China. After feature selection with least absolute shrinkage and selection operator (LASSO) regression, a multivariable Cox-based nomogram was constructed, and its performance was assessed using time-dependent receiver operating characteristic curves, calibration plots, decision curve analysis (DCA), and risk stratification. The final nomogram incorporated nine predictors: age, primary tumor site, histological grade, tumor size, N stage, bone metastasis, carcinoembryonic antigen status, metastasectomy, and chemotherapy. It showed stable discrimination across the training, internal validation, and external validation cohorts, with 12-month areas under the curve (AUCs) of 0.791, 0.714, and 0.778 and 24-month AUCs of 0.742, 0.740, and 0.730, respectively; calibration was good in all cohorts, and DCA supported potential clinical utility. Nomogram-based risk stratification separated patients into prognostically distinct low- and high-risk groups, and an exploratory analysis indicated that the survival benefit of PTR was largely confined to low-risk patients. This externally validated nomogram provides individualized survival prediction and risk stratification for patients with CRC-SLLM and may help identify those more likely to benefit from PTR, although this finding remains exploratory and warrants confirmation in prospective multicenter studies.<\/jats:p>","DOI":"10.3389\/fonc.2026.1915006","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T04:27:05Z","timestamp":1790310425000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Development and external validation of a nomogram to predict survival and guide surgical strategy for colorectal cancer with synchronous liver and lung metastases: a SEER-based analysis"],"prefix":"10.3389","volume":"16","author":[{"given":"Hongqing","family":"Ma","sequence":"first","affiliation":[{"name":"The Second Department of Surgery, The Fourth Hospital of Hebei Medical University","place":["Shijiazhuang, 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China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of General Surgery, The Second Hospital of Hebei Medical University","place":["Shijiazhuang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guiying","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of General Surgery, The Second Hospital of Hebei Medical University","place":["Shijiazhuang, China"]},{"name":"Hebei Key Laboratory of Etiology Tracing and Individualized Diagnosis and Treatment for Digestive system carcinoma","place":["Shijiazhuang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,25]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21660","article-title":"Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 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